Virtual Global Summit on Precision Diagnosis and Treatment of Prostate Cancer Archives

Current Clinical Utility of MRI and Multi-Modality Imaging

Posted by Masoom Haider, MD | Dec 2020

Masoom Haider, MD, Professor of Medical Imaging at the University of Toronto, discusses the clinical utility of multiparametric MRI (mpMRI) in prostate cancer diagnosis, noting current knowledge and practice gaps and highlighting key areas for future research. He explains that while the benefits of mpMRI in biopsy-naïve men at high risk of prostate cancer have been confirmed several times over and it is increasingly recommended prior to biopsy, mpMRI can still miss between 3 and 11% of clinically significant cancers, so some kind of follow-up strategy or safety net is needed. Dr. Haider then discusses the need for a quality assurance system, like PI-QUAL, to ensure that mpMRIs are correctly performed and interpreted, as well as the need for a directed pathway to create a better flow of patients from initial assessment through to follow-up. He also briefly summarizes research on the comparative risks of lesions visible on mpMRI to lesions invisible on mpMRI, reducing mpMRI through better risk stratification, and comparing cancer detection with mpMRI to cancer detection with 68Ga-PSMA PET/CT. He concludes that a great deal remains to be learned both about the long term implications of using mpMRI and about the best ways to use it.

Role of MR-Targeted Prostate Biopsy in Active Surveillance

Posted by Behfar Ehdaie, MD, MPH | Dec 2020

Behfar Ehdaie, MD, MPH, a urologic surgeon at Memorial Sloan Kettering Cancer Center, discusses how MR-targeted prostate biopsy in active surveillance improves detection of higher grade prostate cancer and reduces misclassification of patients with low-risk disease. He summarizes the findings of studies that demonstrate MR-targeted biopsy’s superiority over systematic biopsy in detecting cancer, the particular benefits of MR-ultrasound software fusion prostate biopsy as compared to visually targeted biopsy, and the importance of combining MR-targeted biopsy with systematic biopsy since some tumors are not visible on MRI. Dr. Ehdaie also notes that patients on active surveillance particularly benefit from scheduled MR-targeted biopsies since only using changes in surveillance MRI and clinical stage to trigger biopsy can cause many higher grade cancers to be missed. Dr. Ehdaie concludes by emphasizing the importance of using a transperineal biopsy technique as opposed to a transrectal one in order to reduce complications and improve cancer detection.

PSMA PET Imaging in Advanced Prostate Cancer

Posted by Jérémie Calais, MD, PhD | Dec 2020

Jeremie Calais, MD, MSc, Assistant Professor and Director of the Clinical Research Program of the Ahmanson Translational Theranostics Division at UCLA, discusses the use of prostate-specific membrane antigen PET imaging, or PSMA PET, in diagnosing advanced prostate cancer. Noting that PSMA PET is currently the most sensitive imaging technique, he reviews well-known studies, STOMP and ORIOLE, and shares patient success stories of PSMA PET guided therapy. PSMA PET is able to detect tumor deposits of 4.5 mm with 90% accuracy and 2.3 mm with 50% accuracy making it more effective in locating disease migration. However, there will still be some micrometastases that are too small to yet be detected by PSMA PET. Because active distant lesions are not successfully identified under all imaging types, Dr. Calais proposes including the modality employed when stating a patient’s disease progression; for example, “mCRPC by PSMA-PET,” thereby expressing the means by which the disease stage was determined. PSMA PET can be used to follow disease mutation and more quickly identify non-metastatic castration-resistant prostate cancer.